# Anatomical Burden of Prior Percutaneous Coronary Intervention and Long-Term Outcomes After Coronary Artery Bypass Grafting: An Analysis Spanning 2 Decades

## TL;DR

This study finds that multiple prior heart procedures increase risks after heart bypass surgery, with more complications and lower survival rates.

## Contribution

The study introduces a novel analysis of how the number of prior heart procedures affects long-term outcomes after bypass surgery.

## Key findings

- Multiple-lesion PCI was linked to higher risks of cardiac death, heart attack, and repeat procedures.
- Single-lesion PCI had outcomes similar to no prior PCI except for increased heart failure hospitalizations.
- Long-term survival was significantly lower in the multiple-lesion PCI group compared to others.

## Abstract

This study aimed to determine whether the anatomical burden of prior percutaneous coronary intervention (PCI) influences long-term outcomes after coronary artery bypass grafting, beyond the impact of intervention presence alone.

This retrospective study analysed consecutive patients undergoing coronary artery bypass grafting at a single institution between 2000 and 2024. The inclusion criteria comprised isolated, non-emergent surgery. Patient categorization was based on prior PCI-treated lesions: none, single, or multiple. The primary end-point was long-term overall survival. The secondary end-points included cardiac death, myocardial infarction, stroke, heart failure hospitalization, and repeat revascularization. Long-term outcomes were assessed using Kaplan-Meier analysis and Cox multivariable models, adjusting for 26 clinical factors.

Of 2442 patients, 1205 met the inclusion criteria (755 none, 227 single-lesion, 223 multiple-lesion intervention). Over a median follow-up of 12.0 (interquartile range, 11.3-12.9; maximum: 24.2) years, the multiple-lesion intervention group had higher rates of in-hospital acute kidney injury (34.1% vs 21.1% vs 24.2%, P = .003). Overall survival differed significantly between groups over the follow-up period (log-rank P = .004), with 15-year survival rates of 35.8%, 46.0%, and 48.0% for multiple-lesion, single-lesion, and no prior PCI groups, respectively. After adjustment, multiple-lesion intervention was associated with increased risks of cardiac death (adjusted subdistribution hazard ratio: 1.91), myocardial infarction (2.26), and repeat revascularization (1.92) compared with no prior intervention.

Multiple-lesion PCI was associated with higher long-term risks of cardiac death, myocardial infarction, and repeat revascularization, while stroke risk was similar. Single-lesion PCI showed outcomes comparable to no prior PCI except for higher heart failure hospitalization. These findings require confirmation in larger, multicentre comparative studies to address residual confounding.

4456.

Coronary artery bypass grafting (CABG) remains the standard treatment for complex coronary artery disease, particularly in patients with diabetes and high anatomical complexity.